A new national report card on premature births gives Iowa a letter grade of “B” as 9.2% of births in the state are early, just below the national average of 9.9%.

Stacey Stewart, president of the March of Dimes, says while Iowa’s numbers are improving, they’re still unacceptably high.

“When babies are born prematurely, that means their health is really threatened at the time of birth and often these are babies that grow into children and young adults who experience health challenges down the road,” Stewart says. “In fact, prematurity and the consequences of prematurity are the leading causes of death for children between the ages of zero and five and it’s the leading cause of infant mortality.”

There’s an “alarming trend” in the U.S. of babies being born too soon, according to Stewart. The preterm birth rate rose for the third year in a row, a trend signaling an urgent health crisis for moms and babies.

More than 700 American women die in childbirth each year and some 50,000 suffer life-threatening complications, making the U.S. the most dangerous developed country in which to give birth.

Stewart says, “If we look at all of these outcomes around moms and babies, what we’re finding in the U.S. is that we have unacceptably high outcomes, especially for the wealthiest country in the world, and especially given the sophistication of our health care system.”

This is the 11th year the March of Dimes is releasing the annual Premature Birth Report Card, which grades all 50 states on their rates of preterm birth and reveals racial, ethnic and geographic disparities within each state.

In Iowa, the preterm birth rate among black women is 29-percent higher than the rate among all other women.

“We need to make sure we do even more to make sure there’s expanded health care coverage for women, that there’s accessability of that coverage for those women wherever they live,” Stewart says. “Even if they live in rural areas, that shouldn’t mean that they have to be denied the health care coverage they need, especially the prenatal care that they may need.”

To encourage supporters to raise awareness and advocate for policies that protect moms and babies, the March of Dimes launched a nationwide campaign called #BlanketChange. It aims to bring attention to the urgent health crises moms and babies face, including increased rates of maternal mortality and preterm birth.

Iowa’s “B” on the report card was shared by 14 other states, and only one state, Vermont, rated an “A.” There were 16 “C” grades, 14 “Ds” and four “Fs” for Alabama, Louisiana, Mississippi and West Virginia.